Penerapan Pelayanan Kefarmasian melalui Model Supervision-Adherence-New Techniques Utilization-Networking (SANTUN) dalam Home Care Penyakit Diabetes Melitus Tipe 2 yang Disertai Hipertensi pada Usia Lanjut

Yuhansyah Nurfauzi, Prof. Dr. apt. Djoko Wahyono, S.U.; Dr. apt. Fita Rahmawati, Sp.FRS; Dr. apt. Nanang Munif Yasin, M.Pharm

2024 | Disertasi | S3 Ilmu Farmasi

Seiring dengan peningkatan populasi lansia di Indonesia, muncul masalah kesehatan. Banyak lansia yang menggunakan obat rutin di rumah untuk mengatasi masalah kesehatannya. Penelitian ini berupaya untuk mengembangkan intervensi pelayanan kefarmasian home pharmacy care (HPC) bagi pasien lansia yang mengalami penyakit kronis. Penerapan model Supervision-Adherence-New Techniques Utilization-Networking (SANTUN) dalam home care DM tipe 2 yang disertai dengan pengobatan hipertensi pada usia lanjut bertujuan untuk mengetahui dampak perubahan pada outcome pasien. Penelitian terdiri dari 3 tahap dan menggunakan mix methods. Tahap I adalah studi pustaka, termasuk tinjauan sistematik, dan studi pendahuluan. Tahap II merupakan pengembangan teknik-teknik baru dalam home care, FGD dan pengembangan model SANTUN serta pelatihan. Tahap III adalah penerapan model dan pengukuran outcome HbA1c, kualitas hidup, serta tingkat pengetahuan. Jenis dan rancangan penelitian pada tahap I dan II adalah studi observasional dan studi kualitatif, sedangkan pada tahap III menggunakan quasi experimental study dengan rancangan pretest-posttest control group design. Subjek penelitian adalah apoteker, tenaga kesehatan yang terkait prolanis, dan pasien usia lanjut yang mendapatkan obat DM tipe 2 bersama dengan obat hipertensi yang memenuhi kriteria inklusi di Cilacap. Penerapan model berupa HPC sebanyak 3 kali home visit dilakukan terhadap 36 pasien oleh 6 orang apoteker yang bekerja di klinik, puskesmas, serta apotek. Penelitian bertempat di fasilitas pelayanan kefarmasian tersebut, ruang FGD, dan di rumah pasien. Instrumen yang digunakan adalah perekam audio, panduan FGD, kuesioner WHO QOL-BREF, kuesioner tingkat pengetahuan, panduan model SANTUN dalam home care, serta materi edukasi untuk pasien dan keluarganya. Analisis data pada tahap I dan II dilakukan secara deskriptif dan kualitatif ditambah dengan uji Wilcoxon, sedangkan pada tahap III menggunakan uji beda. Studi menunjukkan bahwa berbagai aktivitas supervisi dapat dikembangkan dan dilakukan oleh apoteker untuk mengoptimalkan HPC. Dengan usual care, parameter HbA1c, tekanan darah, GDP, dan GDPP pasien belum terkendali. Model SANTUN diperoleh melalui formulasi hasil studi pustaka, studi pendahuluan dan analisis kebutuhan, serta FGD. Model ini merupakan pendampingan apoteker (supervision) untuk menilai kepatuhan (adherence) pasien melalui rekonsiliasi obat dan pill count, serta menerapkan Beer’s kriteria. Model ini juga mengintegrasikan teknik-teknik baru (new techniques utilization) saat pelaksanaan HPC melalui pemeriksaan kaki oleh apoteker dan edukasinya sesuai dengan kebutuhan lansia DM yang memungkinkan keterlibatan keluarga pasien (networking). Penerapan model SANTUN pada kelompok home care secara bermakna dapat menurunkan HbA1c menjadi 5,81±1,96% (p<0>

Along with the increase in the elderly population in Indonesia, health problems also arise. Many elderly people use regular medicines at home to treat their health problems. This research seeks to develop a pharmaceutical service intervention called home pharmacy care (HPC) for elderly patients with chronic diseases. The application of the Supervision-Adherence-New Techniques Utilization-Networking (SANTUN) model in home care for type 2 DM accompanied by hypertension treatment in the elderly aims to determine the impact of changes on patient outcomes. The research consisted of 3 stages and used mix methods. Phase I is a literature study, including a systematic review, and a preliminary study. Phase II is the development of new techniques in home care, FGD and the development of the SANTUN model and training. Stage III is the application of the model and measurement of HbA1c outcomes, quality of life, and level of knowledge. Types and research designs in stages I and II were observational studies and qualitative studies, while in stage III a quasi-experimental study was used with a pretest-posttest control group design. The research subjects were pharmacists, Prolanis-related health workers, and elderly patients who received type 2 DM drugs along with hypertension drugs that met the inclusion criteria in Cilacap. The application of the HPC model in the form of 3 home visits was carried out on 36 patients by 6 pharmacists who worked in clinics, health centers, and pharmacies. The research took place at the pharmaceutical service facility, FGD room, and at the patient's home. The instruments used were audio recorders, FGD guides, WHO QOL-BREF questionnaires, level of knowledge questionnaires, guidance on the SANTUN model in home care, as well as educational materials for patients and their families. Data analysis in stages I and II was carried out descriptively and qualitatively coupled with the Wilcoxon test, while in stage III using a different test. Studies show that various supervision activities can be developed and carried out by pharmacists to optimize HPC. With usual care, the clinical parameters of elderly prolanis patients who have type 2 DM accompanied by hypertension have not been controlled. The SANTUN model was obtained through formulating the results of literature studies, preliminary studies and needs analysis, as well as FGDs. This model is a pharmacist's assistance (supervision) to assess patient adherence through medication reconciliation and pill count, as well as applying Beer's criteria. This model also integrates new techniques utilization during the implementation of HPC through foot examinations by pharmacists and education according to the needs of DM elderly which allows the involvement of the patient's family (networking). The application of the SANTUN model in the home care group can significantly reduce HbA1c to 5.81 ± 1.96% (p<0>

Kata Kunci : home care, pelayanan kefarmasian, DM Tipe 2, hipertensi, usia lanjut